Friday, September 25, 2009

Varying Opinions on Midwifery Licensure

As an organization, Citizens for Midwifery supports the Big Push campaign and is also a partner in the MAMA campaign. However, I think it important to acknowledge that there are strong differences of opinion within the "birth world" about legislative "solutions" in midwifery. I frequently post updates and alerts from various campaigns to this blog. However, there are women who caution that licensing and legislation have unforeseen consequences and I think it is both fair and important to listen to their voices too.

Carla Hartley and Gloria Lemay are women that I admire and respect and both of them have recently voiced their concerns via their blogs about licensing midwives.

My personal feelings about midwifery legislation were deeply shaped by the experiences of living in Missouri for my entire life, in which until last year, the practice of midwifery was a felony. A felony is a serious thing and our intense legislative efforts in Missouri were able to remove that obstacle. There are those who expressed concern about taking a legislative approach, feeling that it was better to leave things as they were and cautioning that legislation has its own risks. I think it certainly is important to be mindful of risks, but I also feel (and felt) very strongly that leaving midwifery a felony was the worst possible tactic to take. I take an, "anything is better than midwives being FELONS!" perspective. Additionally, I felt strongly that it was unethical, impractical, and illogical to assume and trust that another woman would be willing to break the law for me and my family by attending my births--that is a LOT to expect from another woman and from her family, who is by extension also put at significant risk. I couldn't ethically continue to expect that. I do not claim to know for certain if pushing for licensure is the correct answer for every state, however, and I find it important to listen to both sides of the issue. There are a lot of very informed people working on legislative campaigns and I place a great deal of trust in their wisdom and expertise! I also believe that they have the best interests of the consumer at heart.

5 comments:

Amen!! Thank you, Molly, for speaking my heart! As much as I support licensure efforts, we only hurt ourselves when we don't stop and listen to wise people who are stating the hard facts about what licensure does. It's easy to ignore reality and hope that it won't happen to you and your state, but I never want to find that I have led people to a place they never wanted to go, by telling them to trust me and it would all be fine and best for them! The wisest men listen closely and seriously to their critics!

Because we all value the right to free expression, I salute Citizens for Midwifery for making room on its blogspot for dissenting views. However, readers should be aware that, as a national member of The Big Push for Midwives, CfM as an organization is solidly in favor of midwifery licensure and regulation -- as am I. I am a consumer of midwifery services and a member of the Steering Committee of the Big Push. The blogs you are citing, Molly, talk about the pros and cons of licensure for midwives. But that's really a perspective of self-interest for the midwife. The focus should really be on the consumer. And consumers are better off in states where midwives are licensed and regulated. That's because in such states the consumer can easily find a midwife, can easily determine what the midwife's credentials are and can feel assured that the information is accurate, and will be able to file a complaint with a government agency that has enforcement authority if the midwife is incompetent or engages in professional misconduct. Midwives are wonderful and consumers love their midwives, but midwives have to be accountable and held responsible for their actions just as other health care providers (and almost all professionals) are held accountable -- through a regulatory board. Most consumers don't want to take the risk that their midwives will be arrested, would prefer not to have to hunt one down through an underground economy, would like the option of having their health insurance pay part of the cost, and want to be assured that a knowledgeable professional board is there should disciplinary action become necessary. We are not talking about the old-style of regulation with medical boards in charge, as in California or Louisiana, but the new model licensure laws that create midwifery boards made up of midwives.Unlicensed midwives are no worse off in a state where midwives are licensed, and in many cases are better off because midwifery statutes do not make unlicensed practice a felony. In unlicensed states, midwives are often subject to arrest and prosecution. In states with licensure, midwifery boards tend to leave their unlicensed colleagues alone or, if they do come to board attention, are handled on an administrative -- not criminal -- basis.I invite everyone to come take a look at the website of the Big Push for Midwives to find out all the exciting developments in the movement toward licensure for all midwives (www.thebigpushformidwives.org).

For one, Canada has an entirely different system for regulating health care providers and for another, the idea that licensing and regulating midwifery inevitably leads to onerous restrictions on practice is a myth.

Midwives are no different from other health care providers. They can--and have--pass laws providing for self-regulation. And the flip side of this coin is that zero regulation of health care professions puts the public at risk.

Absolutely, Susan, CfM supports midwifery licensure and has done so for many years as well as being a founding or supporting member of causes promoting licensure!

It came to my attention last week, that while I frequently update this blog with action alerts from various campaigns, I've ignored dissenting perspectives on this blog until now--I don't think that has been fair of me and I wanted to acknowledge that there are other perspectives out there.